Dystonia represents the neurological condition which features with twisting of the body and repetitive movements. The body may have the abnormal posture as well. Since there is no definitive cure for the disease the doctors are using certain medications and surgery to limit the movements and bring them under control. Sometimes even a combination of the drugs is administered in order to help the patient.
The group of medications includes anticholinergics, benzodiazepines, dopamine agonists and antagonists and Carbamazepine. Botulinum toxin is used as well. In addition to medications the patient undergoes the physical treatment and in the worst cases surgical methods are applied.
Anticholinergics are a group of medications which function as inhibitors of acetylcholine. This neurotransmitter has huge role in nervous system functioning. These drugs are efficient in focal forms of dystonia. Sometimes high dosages of the drugs are administered. The side effects are dry mouth, blurred vision, constipation and urine retention and confusion. Benzodiazepines are in charge of GABA (gamma-aminobutyric acid) regulation. This neurotransmitter helps the brain to preserve the control over muscles. These medications lead to sedation, reduce anxiety and posses muscle relaxing properties. Side effects include sleepiness and confusion. There is one drug called Baclofen which is also used for the condition. It relaxes the muscles and if it given in low doses it is free of side effects. Dopamin agonists and antagonists are also used but they can sometimes lead to new abnormal movements such as tardive dyskinesia. Therefore they must be administered with huge amount of precaution. Carbamazepine is anti epileptic drug which is helpful in small number of patients. All of the previously mentioned drugs may be combined.
Injections of botulinum toxin have been used since 1980s. The goal of the treatment is to improve the function of the muscles and to allow the body to take normal posture. Focal and localized forms of dystonia respond better to botulinum injections than other forms of the disease. The toxin needs to be re-injected after three months. It is applied in painful areas, into the muscles which are responsible for abnormal movements and places of visible contractions. There are no side effects if they are injected properly. This therapy is effective in majority of patients. The only problem is that some people tend to develop resistance to the toxin.
Surgical procedures are kept only for the most extreme cases which do not respond either to medications or to botulinum injections. The surgery includes cutting of the nerves and muscles or careful placement of lesions in the basal ganglia of the brain. In generalized dystonias the parts of thalamus are destroyed. This carries risk of developing troubles with speech since thalamus is quite near the brain area responsible for speech. This all is done to reduce the abnormal movements. So it can be said that the surgery has basically destructive goals. There is also possibility of deep brain stimulation. Additionally microvascular decompression can be done. This procedure is done as some consider that arteries may press selected nerves and lead to dystonic movements.
Physical therapy includes therapy with ice, heat or ultrasound. Speech therapy as well as acupuncture chiropractic techniques can be conducted. Relaxation techniques, meditation and behavior therapy may be recommended.